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NPI Code Detail

MEDICARE: CLINICA MEDICA MI PUEBLO, MEDICAL CLINIC, INC

MEDICARE: CLINICA MEDICA MI PUEBLO, MEDICAL CLINIC, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1679824437
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICA MEDICA MI PUEBLO, MEDICAL CLINIC, INC
Provider Business Mailing Address
First Line : 6055 E WASHINGTON BLVD
Second Line : SUITE 240
City : COMMERCE
State : CA
Zip : 90040-2449
Country : US
Telephone Number : 323-726-0333
Fax Number : 323-726-0313
Provider Business Practice Location Address
First Line : 5835 N FIGUEROA ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-4227
Country : US
Telephone Number : 323-258-8600
Fax Number : 323-258-8610
Authorized Official
Title or Position : OWNER
Name : DR. THOMAS J MAGEE
Credential : MD
Telephone Number : 323-726-0333
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/19/2012

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Directions to “CLINICA MEDICA MI PUEBLO, MEDICAL CLINIC, INC ” Practice Location

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